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Rhinosinusitis is a very common disease worldwide and specifically in the US population. It is a common disease in children but may be underdiagnosed. Several reasons may account to the disease being missed in children. The symptoms in children are limited and can be very similar to the common cold or allergic symptoms. Cough and nasal discharge ma...
Citations
... Chronic rhinosinusitis (CRS) is a chronic inflammation of sinonasal mucosa having a significant impact on children health [1]. Although the data on the epidemiology of chronic rhinosinusitis are inconsistent, the most recent study has demonstrated that chronic rhinosinusitis accounts for 5.6 million visits per annum in the USA [2]. ...
The objective of the present study was to assess hair, serum, whole blood, and excised tissue essential element content in children with chronic rhinosinusitis (CRS). Eighty-eight children with chronic rhinosinusitis and 66 healthy controls were enrolled in the present study. Evaluation of endoscopic Lund-Kennedy and computed tomography Lund-Mackay scores, as well as tissue sampling, was performed only in children with chronic rhinosinusitis. Assessment of Sino-Nasal Outcome Test-20 (SNOT-20) scores was performed in both cases and controls. Hair, whole blood, blood serum, and excised mucosal tissue (only in patients) analysis was performed using inductively coupled argon plasma mass-spectrometry. The obtained data demonstrate that whole blood Ca, Mg, Se, and Zn, as well as hair Ca, Cu, Mg, and Zn levels in the examined patients were significantly lower as compared with the control values. Only serum Zn concentration in children with CRS exceeded the respective control values, whereas serum Cu levels only tended to decrease in CRS. In turn, hair Fe content in children with CRS exceeded that in healthy controls. Regression analysis demonstrate that hair Ca levels, as well as whole blood Ca, Se, and Zn concentrations, were considered as negative predictors, whereas increased hair iron level was significantly directly associated with CRS. Significant associations between hair, serum, whole blood, and tissue element levels and Lund-Kennedy and Lund-Mackay scores were also revealed. Generally, the obtained data demonstrate that chronic rhinosinusitis is associated with impaired essential metal levels in pediatric patients with chronic rhinosinusitis. The observed alterations may contribute to CRS pathogenesis through modulation of mucociliary clearance, immunity, inflammatory response, and redox environment.
... Chronic rhinosinusitis is a common inflammatory disorder of nasal cavity and paranasal sinuses that has significant adverse effects on children's health (1) . Chronic rhinosinusitis is defined as the presence of characteristic clinical symptoms including nasal congestion, postnasal drainage, purulent rhinorrhea, low-grade hyperthermia, irritability, and cough during more than 12 weeks (2) , confirmed by objective investigation using sinonasal endoscopy and computed tomography (CT) (3) . ...
Background:
The objective of the study is evaluation of ciliary function and mucosal cytology after endoscopic sinus surgery in children with chronic rhinosinusitis (CRS).
Methodology:
A total of 132 children with CRS who underwent endoscopic sinus surgery, as well as 15 healthy controls were involved in the study. In this follow-up study patients were examined preoperatively, as well as 3, 6, 9, and 12 months after endoscopic sinus surgery. Assessment of ciliary function and sinonasal mucosal cytology was performed using high-speed videomicroscopy. Lund-Kennedy, Lund-Mackay, and sinonasal outcome test 20 (SNOT20) scores were also evaluated.
Results:
Total SNOT-20, Lund-Mackay, and Lund-Kennedy values significantly decreased after sinus surgery. In contrast, ciliary function and mucosal cytology only tended to improve after 6 months. 9 months after surgery the number of ciliated cells, ciliary beat frequency, cell viability, and ciliary length were significantly higher than preoperatively. The most significant improvement of ciliary function and cell height was observed 12 months after operation, whereas epithelial dystrophy and neutrophil infiltration were significantly reduced.
Conclusions:
Substantial improvement was observed only in a year after surgery, whereas 0 to 3 months after the surgery ciliary function was severely impaired thus predisposing to recurrent sinusitis or other complications.
... Immunotherapy is a treatment that has been shown to reduce allergy symptoms in the long term [11,13]. In addition, immunotherapy may decrease the inflammatory response [6,14] and improve the quality of life of children with CRA [15]. ...
Background
Chronic rhinosinusitis allergy (CRA) is a disease that is commonly found in children and is mostly caused by allergy to house dust mites (HDM). The use of HDM immunotherapy can be considered in children with allergies.
Objectives
Analyzing the impact of mite immunotherapy on disease burden in Indonesian children with CRA.
Methods
A randomized control trial study was conducted to participants in 2 groups, namely the immunotherapy group (n = 25) and the non-immunotherapy group (n = 25). Participants were given HDM immunotherapy for 14 weeks, which was given once per week. Participants during therapy were evaluated for rhinosinusitis symptoms and measured their immunity status (specific IgE), sleep quality (SDSC), quality of life (SN5), and family coping (F-COPES) pre-post therapy. Statistical analysis used in this study included paired t-test, Wilcoxon test, independent t-test, or Mann Whitney test with p < 0.05.
Results
The value of specific IgE in the immunotherapy group was 4.12 ± 7.75 kU/l (pre-test) and 1.52 ± 2.42 kU/l (post-test; p < 0.001), while in the non-immunotherapy group was 1.47 ± 3.28 kU/l (pre-test) and 1.18 ± 2.81 kU/l (post-test; p = 0.317). The SDSC value in the immunotherapy group was 42.16 ± 2.75 (pre-test) and 30.32 ± 3.22 (post-test; p < 0.001), while in the non-immunotherapy group was 41.92 ± 2.75 (pre-test) and 41.84 ± 2.87 (post-test; p = 0.987). The F-COPES value in the immunotherapy group was 101.56 ± 5.78 (pre-test) and 105.20 ± 4.31 (post-test; p = 0.015), while in the non-immunotherapy group was 100.36 ± 9.63 (pre-test) and 99.96 ± 9.98 (post-test; p = 0.224). The SN-5 value in the immunotherapy group was 30.04 ± 2.78 (pre-test) and 11.00 ± 2.33 (post-test; p < 0.001), while in the non-immunotherapy group was 30.04 ± 2.78 (pre-test) and 30.04 ± 2.78 (post-test; p = 0.767). There was a significant comparison between the immunotherapy group and the non-immunotherapy group on the specific IgE (p = 0.013), SDSC (p < 0.001), and SN-5 (p < 0.001) values. Meanwhile, there was no significant difference in the F-COPES value (p = 0.129).
Conclusions
The administration of HDM immunotherapy can improve the participant's immunity, quality of life, and sleep disorder.
... Desde hace 20 años, el término de rinosinusitis sustituye al de sinusitis en los niños [1][2][3] , porque, además de que las mucosas nasales y sinusales están en continuidad entre sí, en lo que respecta a la patología inflamatoria, la afectación de la nariz precede siempre a la afectación sinusal. En los niños, es excepcional que la afectación de la mucosa sinusal preceda a la de la nariz, como sucede en algunas sinusitis dentales o las sinusitis de las enfermedades sistémicas [1,4] . ...
... El tratamiento de las rinosinusitis crónicas infantiles lo realizan médicos muy diversos: médicos generales, pediatras, otorrinolaringólogos (ORL), alergólogos, neumólogos y otros, por lo que es necesario tener una terminología común. Cuadro 1. Clasificación de las rinosinusitis crónicas infantiles en función de la existencia o no de pólipos y de las células inflamatorias predominantes [2,5] . ...
... Estos síntomas son muy triviales en los niños y poco específicos, por lo que existe el riesgo de establecer un diagnóstico de rinosinusitis crónica por exceso. Por tanto, es necesario obtener más datos mediante la endoscopia nasal o la TC [2,4,15] . Cuadro 2. Escala clínica de la poliposis nasal. ...
Resumen
Las rinosinusitis crónicas no son infrecuentes en la infancia. El diagnóstico se basa en la presencia de obstrucción nasal o de rinorrea de más de tres meses de evolución, asociada a anomalías de las mucosas, en la endoscopia nasal o en la tomografía computarizada. La clasificación según el fenotipo (con y sin poliposis nasal) es menos interesante que la establecida según los endotipos (basada en biomarcadores), que se aproxima más a la patogénica y, por tanto, a los tratamientos posibles, al menos en el futuro. El estudio inicial consta de una exploración otorrinolaringológica, un estudio alergológico, una pH-metría y la búsqueda de asma. Dependiendo de estos primeros resultados, puede ser útil solicitar una prueba de imagen, un estudio inmunitario o buscar una discinesia ciliar. El tratamiento se basa en unos cuidados endonasales prolongados. Los tratamientos farmacológicos probablemente evolucionarán en los próximos años. Los tratamientos quirúrgicos se reservan a las formas más graves y deben ser lo menos agresivos que sea posible.
... The signs and symptoms of this disease in children are nonspecific and include cough, fever, headache, rhinorrhoea, post-nasal drip, and nasal congestion (5,6). Paediatric rhinosinusitis is diagnosed by 3 methods: the clinical method, nasal endoscopy, and imaging (7)(8)(9). ...
Background: Computed tomography scans (CT scan) and X-rays are used to diagnose paediatric maxillary sinusitis. This study aimed at exploring the diagnostic value of the conventional and colour Doppler ultrasounds and their specific findings in cases of paediatric sinusitis.
Methods: A total of 60 children diagnosed with sinusitis were included in this study. The conventional and colour Doppler ultrasounds of the sinus were performed on each of them. The symptoms that suggested increased blood flow to the sinuses were interpreted as positive findings on the colour Doppler ultrasound and were named "Ghasemi signs" for the purpose of this study. Such symptoms included unilateral artery bumps on the front artery, reduction of arterial resistive index (RI) to less than 0.5, and diameter of 2 mm or above for maxillary arteries. Sensitivity, specificity, and positive and negative predictive values, and accuracy of the conventional and colour Doppler ultrasounds were also calculated.
Results: Compared to CT scan, the conventional ultrasound showed sensitivity and specificity of 73.4% and 100%, respectively. Sensitivity and specificity for the colour Doppler ultrasound were 89.36% and 100%, respectively. The maxillary artery diameter in normal and affected maxillary sinuses were, respectively, 2.4 mm (2.1–2.6, 95% CI) and 1.7 mm (1.6–1.9, 95% CI), with p<0.001. The RI of the affected sinuses were 0.47 (0.45–0.49, 95% CI), and those of the normal sinuses were 0.58 (0.54–0.61, 95% CI), with p<0.001.
Conclusion: The findings of this study revealed that the conventional ultrasound agrees with the CT scans in the diagnosis of paediatric maxillary sinusitis. This diagnostic modality becomes even more valuable when the colour Doppler is used, particularly when considering the specific symptoms (Ghasemi signs) suggested by this study.
... It is often overlooked especially in children because the symptoms in children are limited and can be very similar to the common cold or allergic symptoms. Thus, a high index of suspicion is necessary to make the diagnosis of rhinosinusitis in these children as it has high propensity to become chronic, however, its complications are unusual but can carry a high morbidity and [3]. Rhinosinusitis in itself is a complication of upper respiratory infections which are the most common illnesses evaluated by the primary care paediatrician. ...
... It is considered that infections induce infl ammation of the sinus mucosa that can extend to the jawbone causing osteitis, further complicating the symptoms and evolution of the disease. [5] Bacterial biofi lms especially Staphylococcus aureus and anaerobic bacteria may contribute to persistence, recurrence and severity of certain clinical forms of CRS. [6] CRS manifests more subtly and according to the diagnostic guidelines, major signs and symptoms are facial pain/pressure/ fullness, nasal obstruction/blockage, nasal or postnasal discharge/purulence, hyposmia/anosmia and fever. ...
... An estimated 0.5-5% of these cases proceed to acute rhinosinusitis, and an unknown number of these children will develop CRS. 3 If left untreated, these conditions could lead to long-term symptoms, such as nasal airway obstruction, congestion, rhinorrhea, cough, headache, and daytime fatigue. Rhinosinusitis can adversely affect the lives of children and their caretakers due to missed school and work days, respectively, and increase need to utilize the health care system. ...
... CT scans may also be necessary for planning of limited FESS as the definitive treatment in cases of exhausting all medical therapies. 3 Whenever CT imaging is necessary, a low-dose radiation protocol can be used, which scans at an equivalent of almost 1/7 th the standard dose of radiation received from prior protocols for CT sinus imaging. 17 These changes are important to minimize radiation exposure in children. ...
Objectives/hypothesis:
Chronic rhinosinusitis(CRS) results in significant morbidity and health care expenditure. Safety and efficacy of nasal irrigation use in the treatment of pediatric CRS have been demonstrated, but long-term outcomes are unknown. We reviewed characteristics and treatment outcomes after 6 weeks of once daily nasal irrigation in pediatric CRS based on computed tomography (CT) scans, and summarized parental reports of subsequent use of nasal irrigation for recurring symptoms
Study design:
Retrospective cohort study and cross-sectional survey.
Methods:
Review and survey of 144 pediatric CRS patients diagnosed between July 2003 and January 2012.
Results:
One hundred four patients were reviewed. Mean age was 8.0 years, and 65.4% were male. Presenting symptoms included congestion (95.2%), cough (79.8%), rhinorrhea (60.6%), headache (48.1%), and fatigue (40.4%). Comorbidities included positive allergy test (50%), asthma (57.3%), and gastroesophageal reflux disease (28.2%). After 6 weeks, 57.7% of patients reported complete resolution of symptoms. Reductions in Lund-Mackay CT scores were 4.14 and 4.38 on the left and right sides, respectively (P < .001). Of the 54 parents who completed the prospective surveys, 53.7% reported using irrigation again in the past 12 months (median = 1, interquartile range = 3). Only nine patients underwent functional endoscopic sinus surgery (FESS) after the initial 6 weeks. Patients requiring FESS were, on average, 3.6 years older than those who did not receive FESS (P = 0.0005). Median length of follow-up was 48 months (range = 20-113). There were no significant differences in age, Lund-MacKay score changes, and symptom resolution proportions between those who completed the survey and those who did not.
Conclusions:
Nasal irrigation is effective as a first-line treatment for pediatric CRS and subsequent nasal symptoms, and reduces the need for FESS and CT imaging.
Level of evidence:
2b.
... It occurs in all ages with no gender, racial or ethnic predilection. 1,2 Chronic sinusitis is a common disease worldwide, particularly in places with high levels of atmospheric pollution. 3 In pediatric population the term rhinosinusitis is more commonly used to include both acute and chronic infection which can be both viral and bacterial in origin. ...
... Chronic sinusitis is an inflammatory lesion that involves the paranasal sinuses with symptoms and signs that are beyond 12 weeks in duration. 1,3 It commonly presents with nasal stuffiness, mouth breathing, purulent nasal discharge, postnatal drip, snoring, cough, headache, facial fullness, hyposmia, sore throat, halitosis. Features of ocular and cerebral complications may be present at diagnosis 4 Documented and commoner orbital complications include preseptal cellulitis, orbital cellulitis, subperiosteal abscess, and cavernous sinus thrombosis. ...
Chronic sinusitis is an inflammatory lesion that involves the paranasal sinuses with symptoms and signs that are beyond 12 weeks in duration. It commonly presents with nasal stuffiness, mouth breathing, purulent nasal discharge, post natal drip, snoring, cough, headache, facial fullness, hyposmia, sore throat and halitosis. Features of ocular and cerebral complications may be present at diagnosis but are uncommon and can thus result in misdiagnosis. A 15 year old male presented with sudden onset ptosis and other symptoms that initially suggested an intracranial SOL or a Cavernous sinus thrombosis. A CT scan of the head and neck structures identified chronic sinusitis as the only likely pathology. We present this case to highlight an unusual ocular complication of chronic sinusitis.
... The normal morpho-functional aspect of the sinus mucosa depends on three factors: ostial permeability, ciliary function, and the consistency of sinus secretions [3,4]. Any change in these factors can irritate the mucosa of the paranasal sinuses and, by disturbing local homeostasis, can cause inflammation, swelling, mucociliary dysfunction, reduced airflow up to complete obstruction and bacterial proliferation [5]. ...
Chronic rhinosinusitis is a multifactorial disease with pathophysiological mechanisms, which remain unclear, and with a high prevalence worldwide. They generate social problems due to the high number of days of leave and relatively elevated medical expenses. The histopathological and immunohistochemical study that we conducted revealed many lesional aspects of the epithelium of the sinus mucosa, which ranged from hypertrophy, hyperplasia and metaplasia, to erosion and discontinuities. In the chorion of the sinus mucosa there was an inflammatory infiltrate composed mainly of lymphocytes, plasma cells and macrophages, and also a highly developed vascular network. Among immune cells, T-cells appeared to be more numerous than B-lymphocytes and macrophages. We believe that microscopic changes are due mainly to microscopic organisms that make up the biofilm of the sinus cavity, whose virulence has been more or less influenced by exogenous or endogenous factors.
